Effects of Early Palliative Care Integration on Patients With Newly Diagnosed Multiple Myeloma

2020 ◽  
Author(s):  
Keyword(s):  
Multiple Myeloma ◽  
Palliative Care ◽  
Newly Diagnosed ◽  
Early Palliative Care ◽  
Care Integration

Longitudinal Perceptions of Prognosis and Goals of Therapy in Patients With Metastatic Non–Small-Cell Lung Cancer: Results of a Randomized Study of Early Palliative Care

2011 ◽  
Vol 29 (17) ◽  
pp. 2319-2326 ◽  
Author(s):  
Jennifer S. Temel ◽  
Joseph A. Greer ◽  
Sonal Admane ◽  
Emily R. Gallagher ◽  
Vicki A. Jackson ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Small Cell ◽  
Newly Diagnosed ◽  
Small Cell Lung ◽  
Early Palliative Care ◽  
Metastatic Nsclc ◽  
Oncology Care ◽  
To Receive ◽  
Over Time

Purpose Understanding of prognosis among terminally ill patients impacts medical decision making. The aims of this study were to explore perceptions of prognosis and goals of therapy in patients with metastatic non–small-cell lung cancer (NSCLC) and to examine the effect of early palliative care on these views over time. Patients and Methods Patients with newly diagnosed metastatic NSCLC were randomly assigned to receive either early palliative care integrated with standard oncology care or standard oncology care alone. Participants completed baseline and longitudinal assessments of their perceptions of prognosis and the goals of cancer therapy over a 6-month period. Results We enrolled 151 participants on the study. Despite having terminal cancer, one third of patients (46 of 145 patients) reported that their cancer was curable at baseline, and a majority (86 of 124 patients) endorsed getting rid of all of the cancer as a goal of therapy. Baseline perceptions of prognosis (ie, curability) and goals of therapy did not differ significantly between study arms. A greater percentage of patients assigned to early palliative care retained or developed an accurate assessment of their prognosis over time (82.5% v 59.6%; P = .02) compared with those receiving standard care. Patients receiving early palliative care who reported an accurate perception of their prognosis were less likely to receive intravenous chemotherapy near the end of life (9.4% v 50%; P = .02). Conclusion Many patients with newly diagnosed metastatic NSCLC hold inaccurate perceptions of their prognoses. Early palliative care significantly improves patient understanding of prognosis over time, which may impact decision making about care near the end of life.

Early palliative care involvement for children with cancer.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 26-26
Author(s):  
Laila Mahmood ◽  
Ann Dozier ◽  
James Dolan ◽  
Denise Casey ◽  
David Nathan Korones
Keyword(s):  
Palliative Care ◽  
Overall Survival ◽  
High Risk ◽  
Study Entry ◽  
Pediatric Palliative Care ◽  
Newly Diagnosed ◽  
Children With Cancer ◽  
Early Palliative Care ◽  
Palliative Care Consultation ◽  
Care Consultation

26 Background: Although the overall survival of children with cancer exceeds 80%, these children experience significant physical, emotional, social and spiritual suffering. That suffering is even more profound for the 20% of children who succumb to their disease. We therefore conducted a prospective study to assess the feasibility and impact of early palliative care involvement for children with high risk malignancies. Objective: To determine if early palliative care involvement for high risk pediatric oncology patients is feasible, acceptable to patients, families and oncology teams, and helps with symptom management and communication. Methods: This was a prospective survey-based study. Children with cancer treated at University of Rochester were eligible to participate if they had a high risk malignancy, defined as (1) having a newly-diagnosed malignancy with an estimated overall survival of < 50%, (2) requiring hematopoietic stem cell transplantation (HSCT), and/or (3) any relapsed, recurrent or progressive cancer. Parents of these children or children >18YO were surveyed upon study entry, and 3 and 6 months later to assess the impact of early and ongoing pediatric palliative care involvement. Results: 20/25 eligible patients received a palliative care consultation at diagnosis; 16 families participated in the study. Six children had a newly diagnosed high risk malignancy, nine had recurrent disease and one child had a HSCT. Median age of the children was 5 years (0.1-20 year).The most frequent symptoms at the time of study entry were pain (75%), nausea/vomiting (69%), constipation (44%), and fatigue (44%). 75%, 73%, 43% and 43% reported successful treatment of pain, nausea/vomiting, constipation, and fatigue respectively. The proportion of children with each symptom decreased at 3 months except for fatigue. There was high satisfaction with the oncology and pediatric palliative care teams at baseline and 3 and 6 months. No families or oncologists declined an early palliative care consultation. Conclusions: Our results suggest that an early palliative care consultation is feasible for high risk children with cancer and that the palliative care team can work successfully with the primary oncology team to foster symptom control and communication.

scholarly journals Depression and Survival in Metastatic Non–Small-Cell Lung Cancer: Effects of Early Palliative Care

2012 ◽  
Vol 30 (12) ◽  
pp. 1310-1315 ◽  
Author(s):  
William F. Pirl ◽  
Joseph A. Greer ◽  
Lara Traeger ◽  
Vicki Jackson ◽  
Inga T. Lennes ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Small Cell Lung Cancer ◽  
Survival Benefit ◽  
Small Cell ◽  
Newly Diagnosed ◽  
Small Cell Lung ◽  
Early Palliative Care ◽  
Metastatic Nsclc ◽  
Oncology Care

Purpose In a randomized trial, early palliative care (EPC) in patients with metastatic non–small-cell lung cancer (NSCLC) was observed to improve survival. In a secondary analysis, we explored the hypothesis that the survival benefit resulted from improving depression. Patients and Methods In total, 151 patients with newly diagnosed metastatic NSCLC participated in a randomized trial of EPC integrated with standard oncology care versus standard oncology care alone. Depression was assessed at baseline and at 12 weeks with the Patient Health Questionnaire-9 (PHQ-9) and was scored diagnostically by using Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, criteria for major depression syndrome (MDS). Depression response was considered ≥ 50% reduction in PHQ-9 scores at 12 weeks. Survival differences were tested with log-rank and Cox proportional hazards models. Results At baseline, 21 patients (14%) met MDS criteria. MDS significantly predicted worse survival (hazard ratio, 1.82; P = .02). Patients assigned to EPC had greater improvements in PHQ-9 scores at 12 weeks (P < .001); among patients with MDS, those receiving EPC had greater rates of depression response at 12 weeks (P = .04). However, improvement in PHQ-9 scores was not associated with improved survival, except in a sensitivity analysis in which patients who died before 12 weeks were modeled to have worse depression. The group randomly assigned to EPC remained independently associated with survival after adding improvement in PHQ-9 scores to the survival model. Conclusion Depression predicted worse survival in patients with newly diagnosed metastatic NSCLC. Although EPC was associated with greater improvement in depression at 12 weeks, the data do not support the hypothesis that treatment of depression mediated the observed survival benefit from EPC.

scholarly journals Developing a “toolkit” to measure implementation of concurrent palliative care in rural community cancer centers

2017 ◽  
Vol 16 (1) ◽  
pp. 60-72 ◽  
Author(s):  
Lisa Zubkoff ◽  
J. Nicholas Dionne-Odom ◽  
Maria Pisu ◽  
Dilip Babu ◽  
Imatullah Akyar ◽  
...  
Keyword(s):  
Palliative Care ◽  
Rural Areas ◽  
Assessment Tool ◽  
Metastatic Cancer ◽  
Lessons Learned ◽  
Newly Diagnosed ◽  
National Guidelines ◽  
Cancer Centers ◽  
Early Palliative Care ◽  
Implementation Costs

ABSTRACTObjective:Despite national guidelines recommending early concurrent palliative care for individuals newly diagnosed with metastatic cancer, few community cancer centers, especially those in underserved rural areas do so. We are implementing an early concurrent palliative care model, ENABLE (Educate, Nurture, Advise, Before Life Ends) in four, rural-serving community cancer centers. Our objective was to develop a “toolkit” to assist community cancer centers that wish to integrate early palliative care for patients with newly diagnosed advanced cancer and their family caregivers.Method:Guided by the RE-AIM (Reach, Effectiveness–Adoption, Implementation, Maintenance) framework, we undertook an instrument-development process based on the literature, expert and site stakeholder review and feedback, and pilot testing during site visits.Results:We developed four instruments to measure ENABLE implementation: (1) the ENABLE RE-AIM Self-Assessment Tool to assess reach, adoption, implementation, and maintenance; (2) the ENABLE General Organizational Index to assess institutional implementation; (3) an Implementation Costs Tool; and (4) an Oncology Clinicians' Perceptions of Early Concurrent Oncology Palliative Care survey.Significance of results:We developed four measures to determine early palliative care implementation. These measures have been pilot-tested, and will be integrated into a comprehensive “toolkit” to assist community cancer centers to measure implementation outcomes. We describe the lessons learned and recommend strategies for promoting long-term program sustainability.

scholarly journals Patients with multiple myeloma referred for palliative care consultation: from retrospective analysis to future directions to improve clinical outcomes

2021 ◽  
Author(s):  
Maria Caterina Pallotti ◽  
Romina Rossi ◽  
Emanuela Scarpi ◽  
Monia Dall’Agata ◽  
Marianna Ricci ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Palliative Care ◽  
Retrospective Analysis ◽  
Social Issues ◽  
Clinical Symptoms ◽  
Clinical Model ◽  
Early Palliative Care ◽  
Disease Trajectory ◽  
Palliative Care Consultation ◽  
New Treatments

Abstract Introduction New treatments have improved the overall survival of patients with multiple myeloma (MM). At diagnosis and during the course of the disease, patients often report pain and other symptoms. Given the long disease trajectory, psychological and social issues are also frequent. Recently, the potential usefulness of early palliative care (EPC) was hypothesized in the area of hematology. We conducted a retrospective analysis of patients with MM referred to our institute for a palliative care (PC) consultation between January 2017 and June 2020. Our aim was to evaluate the main reasons (pain or other clinical symptoms) for the referral for a first PC consultation. Methods We examined the main reasons for the first PC consultation, the number of PC consultations carried out, and the period of time between diagnosis, first and subsequent PC visits, and death. We also recorded information on the type of pain experienced and the treatments administered. Results Of the 325 patients with MM followed at our hematology unit during the study period, 43 were referred for a PC consultation (39 for pain management and 4 to determine the most appropriate care setting (hospice or palliative homecare service)). Nineteen (44.2%) of the 43 patients reported other symptoms in addition to pain. The median time between MM diagnosis and the first PC consultation was 473 days. Fifteen patients died, with a median 332 days between the first PC visit and death. Conclusion Randomized studies on MM involving larger patient populations with access to EPC are needed to identify an effective clinical model to improve the management of patients with MM.

scholarly journals Patients’ and Parents’ Needs, Attitudes, and Perceptions About Early Palliative Care Integration in Pediatric Oncology

JAMA Oncology ◽  
2017 ◽  
Vol 3 (9) ◽  
pp. 1214 ◽  
Author(s):  
Deena R. Levine ◽  
Belinda N. Mandrell ◽  
April Sykes ◽  
Michele Pritchard ◽  
Deborah Gibson ◽  
...  
Keyword(s):  
Palliative Care ◽  
Pediatric Oncology ◽  
Early Palliative Care ◽  
Care Integration ◽  
Attitudes And Perceptions
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